#{extends 'mainContent.html' /}
#{set title:'Contact Us' /}
#{set 'moreScripts'}
<script type="text/javascript" src="http://download.skype.com/share/skypebuttons/js/skypeCheck.js"></script>
#{/set}
<div style="padding-left:50px;">
<p>
If you have any questions about dental products or need assistance in ordering, <br/>
Please contact us<br/>
<b>Email:</b><a href="mailto:sales@dental-spark.com">sales@dental-spark.com</a><br/>
<b>Phone:</b> +86 15363095730/ +86 0757 81322051<br/>
<b>MSN:</b><a href='msnim:add?contact=yanxw2005@hotmail.com'> <img src="@{'/public/images/msnme.jpg'}" style="border: none;" width="194" height="55" alt="MSN Me??"/></a><br/>
<b>Skype:</b><a href="skype:jamesyanxw?call"><img src="@{'/public/images/skyeme.jpg'}" style="border: none;" width="194" height="55" alt="Skype Me??" /></a>
</p>

<form action="@{submitAppointment()}" method="post" class="commonForm">
#{ifErrors}
   <div class="error">Oops… Please correct the error first.</div>
#{/ifErrors}
#{if flash.success}
    <p class="success">${flash.success}</p>
#{/if}
<table width="100%">
	<tr>
		<td class="label">
			Subject
		</td>
		<td class="value">
			<input type="text" name="a.subject" value="${flash['a.subject']}"/>
		</td>
	</tr>
	<tr>
		<td class="label">
			Name
		</td>
		<td class="value">
			<table width="100%" cellspacing="0" cellpadding="0" border="0">
				<tr>
					<td>
						<input type="text" name="a.firstName" value="${flash['a.firstName']}"/><span class="error">#{error 'a.firstName' /}</span>
					</td>
					<td>
						&nbsp;&nbsp;&nbsp;
					</td>
					<td>
						<input type="text" name="a.lastName" value="${flash['a.lastName']}"/><span class="error">#{error 'a.firstName' /}</span>
					</td>
					<td>
						&nbsp;&nbsp;&nbsp;
					</td>
					<td>
						<input type="text" name="a.degree" value="${flash['a.degree']}"/>
					</td>
				</tr>
				<tr>
					<td>
						* First
					</td>
					<td></td>
					<td>
						* Last
					</td>
					<td></td>
					<td>
						Degree (e.g. DDS)
					</td>
				</tr>
			</table>
			
		</td>
	</tr>
	<tr>
		<td class="label">
			Company
		</td>
		<td class="value">
			<input type="text" name="a.company" value="${flash['a.company']}"/>
		</td>
	</tr>
	<tr>
		<td class="label">
			Address
		</td>
		<td class="value">
			<table width="100%" cellspacing="0" cellpadding="0" border="0">
				<tr>
					<td colspan="5">
						<input type="text" name="a.address" value="${flash['a.address']}"/>
					</td>
					
				</tr>
				<tr>
					<td colspan="5">

						Street
					</td>
				</tr>
				<tr>
					<td>
						<input type="text" name="a.city" value="${flash['a.city']}"/>
					</td>
					<td>
						&nbsp;&nbsp;&nbsp;
					</td>
					<td>
						<input type="text" name="a.state" value="${flash['a.state']}"/>
					</td>
					<td>
						&nbsp;&nbsp;&nbsp;
					</td>
					<td>
						<input type="text" name="a.zipCode" value="${flash['a.zipCode']}"/>
					</td>
				</tr>
				<tr>
					<td>
						City
					</td>
					<td></td>
					<td>
						State
					</td>
					<td></td>
					<td>
						Zip Code
					</td>
				</tr>
			</table>
		
			
		</td>
	</tr>
	<tr>
		<td class="label">
			Phone
		</td>
		<td class="value">
			<input type="text" name="a.phone" value="${flash['a.phone']}"/>
		</td>
	</tr>
	<tr>
		<td class="label">
			Email(*)
		</td>
		<td class="value">
			<input type="text" name="a.email" value="${flash['a.email']}"/><span class="error">#{error 'a.email' /}</span>
		</td>
	</tr>
	<tr>
		<td class="label">
			Messsage(*)
		</td>
		<td class="value">
			<textarea name="a.msg">${flash['a.msg']}</textarea><span class="error">#{error 'a.msg' /}</span>
		</td>
	</tr>
	<tr>
		<td class="label">
			Product Interest
		</td>
		<td class="value">
			<select name="a.productInterest">
				<option>Loupes</option>
				<option>LED Bleaching System</option>
				<option>LED Curing light Unit</option>
				<option>Intraoral camera</option>
				<option>Handpiece</option>
			</select>
		</td>
	</tr>
</table>
<input type="submit" value="submit">
	
</form>
</div>